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Hyperinflation Ex 1
| Question | Answer |
|---|---|
| What are the three types of Atelectasis? | Resorption, Passive, Adhesive |
| What is Resorption Atelectasis? | Obstruction of the bronchus by tumor, mucus, or foreign body |
| What is Passive Atelectasis? | Failure of ability to intermittently stretch alveoli by deep breathing, sighing, or yawning |
| What is Adhesive Atelectasis? | Atelectasis caused by a surfactant deficiency |
| What are the causes of atelectasis? | Cause varies based on the type of atelectasis, but the underlying cause is an inability to open the alveoli |
| What are the signs/symptoms of atelectasis? | Rapid/shallow breathing, increased tactile fremitus, dullness to percussion, fine, late inspiratory crackles, bronchial, or diminished breath sounds |
| How would a CXR confirm atelectasis? | Increased opacities, elevated diaphragm, fissure displacement, mediastinal shift towards the affected side, crowding of ribs on the affected side, compensary hyper-expansion of surrounding lung |
| What is Incentive Spirometry? | Mimics natural sighing, encourages patients to take slow, deep breaths, visual cues monitor patient progress towards the goal |
| What is the SMI - basic maneuver? | Sustained maximal inhalation; a slow, deep inhalation from FRC up to TLC followed by a 5-10 second breath hold |
| What are the indications for IS? | Condition predisposed to atelectasis, upper abdominal or thoracic surgery, COPD patients who will have surgery, presence of atelectasis, restrictive lung defect associated with neuromuscular dysfunction |
| What are the contraindications for IS? | Uncooperative patients, obtunded patients, unconscious patients |
| What are the hazards associated with IS? | Hyperventilation, discomfort, pulmonary barotrauma, exacerbation of bronchospasm, fatigue, hypoxia, ineffective unless supervised or performed as ordered |
| What is the criteria for IS? | Identify goals based on patient ability, baseline assessment, determine pre-op IC to set post-op goal, VC<10ml/kg or IC 1/3 of predicted - consider IPPB |
| What is the volume oriented IS? | Measures volume, during inspiration, as the patient draws air in through the breathing hose bellow rises and indicates volume |
| What is flow oriented IS? | Can be equated with volume by assessing during of inspiration (Flow x Time = Volume) |
| How would you instruct a patient in the use of IS? | Inhale slowly and deeply, hold breath for 5-10 seconds, 30-60 second rest period, repeat 10x per hour |
| What is the definition of IPPB? | Intermittent Positive Airway Pressure |
| How does IPPB affect MAP physiologically? | Increases Mean Airway Pressure |
| How does IPPB affect Intrathoracic pressure physiologically? | Increases Intrathoracic Pressure |
| How does IPPB affect venous return? | Decreases venous return |
| How does IPPB affect cardiac output? | Increased PL causes decreased Cardiac Output |
| How does IPPB affect ICP? | Blood will back up causing increased ICP |
| What are the goals of IPPB? | Provide increased Vt, improve/promote cough, improve distribution of ventilation/reduce atelectasis, deliver meds: improved distribution, improved BS (lung bases), improve oxygenation, favorable PT response |
| How should a patient be positioned for IPPB? | Semi-Fowler's position |
| What is the initial sensitivity setting for IPPB? | -1 to -2 cmH2O |
| What is the initial pressure setting for IPPB? | 10 - 15 cmH2O |
| What is the initial BPM for IPPB? | 6 BPM |
| What is the initial I:E ratio for IPPB? | 1:3 to 1:4 |
| What controls Vt during IPPB? | PIP (positive inspiratory pressure) |
| What controls I-time during IPPB? | Flow |
| What setting is breath triggered during IPPB? | Sensitivity |
| How would you troubleshoot any leaks that occur during IPPB? | Device will not cycle off; check patient and machine for leaks |
| How would you troubleshoot a large negative pressure swing in early inspiration during IPPB? | Check sensitivity |
| How would you troubleshoot a system pressure drop after inspiration during IPPB? | Increase flow |
| What affect can kinked tubing have on IPPB? How would you address this? | Can cause device to cycle off prematurely; fix tubing |
| What affect can an occluded mouthpiece have on IPPB? How would you address this? | Cause the device to cycle off prematurely; coach patient on breathing or switch to mask |
| How would active resistance to inhalation effect IPPB? How would you address it? | Cause the device to cycle off prematurely; coach patient on breathing |
| How are the Bird Mask 7 and the Bennet PR 2 powered? | Pneumatically powered |
Created by:
ashconrad417
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